Global Health Matters September October 2009

8/8/2019 Global Health Matters September October 2009

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GLOBALHEALTHMATTERS

FOGARTY INTERNATIONAL CENTER • NATIONAL INSTITUTES OF HEALTH • DEPARTMENT OF HEALTH AND HUMAN SERVICES

Trans-NIH eort launched on global health

Recovery Act unds ve Challenge Grants

US–Latin America commit to ght cancer .

Global Health Bries . . . . . . . . . . . . . . .

Meeting attendees hear ’stars are aligned’

NIH director Dr. Francis Collins urged members o the new trans-NIH working groupon global health research to fnd better ways to leverage resources and coordinate international activities to improve human health.

IH should capitalize on the current supportive

environment or global health science, its director

Dr. Francis Collins recently urged members o the

newly created Trans-NIH Global Health Research Working

Group.

“Our country is poised to move rom the hard power stance

to sot power or, as Hillary Clinton said, smart power.

Shouldn’t we at NIH be leading that charge?,” he asked.

The high-level working group is the result o a two-year

eort by institute and center directors to analyze global

health research activities at NIH and explore better ways

to coordinate eorts, both across NIH and throughout the

government. The Obama administration has pledged $63

billion to its Global Health Initiative and is seeking input on

its approach.continued on p. 7

P h ot o b y Mi ch a el S p en c er , NI H

N

Global Health on CampusStudent demand or global health programs has doubled and

multidisciplinary collaborations are spurring research innovations…

Read more on pages 8-11.

FOCUS

continued on p. 10

Consortium o Universities or Global Health:

Inside this issue

The president’s $63 billion commitment to global health

over the next six years

New NIH Director Dr. Francis Collin’s designation o

global health as one o his top priorities

Creation o the Consortium o Universities or Global

Health

Creation o a trans-NIH working group on global health,

co-chaired by Glass, and the move by many Institutes

and Centers to include the eld in their strategic plans

Explosive demand among college students or global

health curricula

A highlight o the conerence was a discussion among

presidents o ve leading U.S. universities with global

health programs and their commitment to break down

acacemic walls to involve experts rom nonmedical

To U.S. global health advocates, these may be the best

o times – a confuence o public support, unding or

new policy initiatives and an alliance o universities

to strengthen a eld that students are demanding in

unprecedented numbers.

“The stars are aligned in a way we never would have

anticipated, especially in a period o economic downturn,”

says Fogarty Director Dr. Roger I. Glass. “It’s a dicult

period but we are bucking the trend.”

Fogarty was co-host or the rst meeting o theConsortium o Universities or Global Health at the NIH

campus in September, and Glass, who also is associate

director o the NIH or international research and a

member o the administration’s Global Health Initiative

steering committee, cited the ollowing recent events:

•

•

•

•

•


http://slidepdf.com/reader/full/global-health-matters-september-october-2009 2/162 Fogarty International Cente

SEPT/OCT 2009

Dr. Duane

Alexander,

the long-time

director o the

Eunice Ken-

nedy Shriver

National Insti-

tute o Child

Health andHuman Devel-

opment, has

joined the Fogarty Center as senior

scientic adviser or global mater-

nal and child health research.

“Duane Alexander has devoted

decades to providing leadership to

the pediatric community to improve

the health o women and children

through research,” said Fogarty Di-

rector Dr. Roger I. Glass. “Given the

administration’s keen interest in

this topic, Duane will be instrumen-

tal in our eorts to engage with the

State Department and other agen-

cies to urther the administration’s

$63 billion Global Health Initiative.”

Among Alexander’s achievements

are: the study o the saety o am-

niocentesis; the reduction o mental

retardation rom Hib meningitis; the

reduction in preterm birth among

women who had previously deliv-ered a preterm inant; the dramatic

reduction in sudden inant death

syndrome; and the reduction o

mother-to-child HIV transmission.

Dr. Susan Shurin, deputy direc-

tor o the National Heart Lung and

Blood Institute, will serve as acting

director o NICHD until the position

is lled permanently.

Child healthauthority

Alexanderjoins Fogarty

President Obama visited

NIH to announce that

$5 billion in economic

recovery unds had been

granted beore the end

o the scal year. Here

he looks through a

microscope during a tour

o an oncology laboratory

at the National Cancer

Institute. With him are

Dr. Marston Linehan, let,

NIH Director Dr. Francis

Collins and Health and

Human Services Secretary

Kathleen Sebelius.

President Obama visits NIH

Polio VaccineFigure RuthKirschstein dies

Dr. Ruth

Kirschstein,

a leading

gure in

making

polio vaccine

saer and

decades later

mobilizing

an NIH

response to

the emerging AIDS epidemic, died Oct.

6 at the age o 82 ater a long illness.From 2000-2002, she was acting

director o the NIH.

“Ruth Kirschstein’s brilliant and

passionate dedication to public health

led to the saving o millions o lives

around the world and made her a

true global health hero,” said Fogarty

director Dr. Roger I. Glass. “When I

arrived at Fogarty, she sat me down

and gave me wonderul advice that has

helped me throughout my tenure.”

In the 1950s, Kirschstein led the

search or a saer alternative to

the Salk polio vaccine, resulting in

widespread use at home and abroad

o the Sabin oral vaccine. When AIDSrst appeared in the United States in

the 1980s, Kirschstein and her sta

were met with strong conservative

political opposition to solving the

crisis. Despite this, she mobilized a

research group to track down unding,

investigate the virus and develop

drugs to alleviate or prevent its attack.

Her HIV/AIDS work has global

implications and may prove vital

in areas worst hit by the epidemic,

especially Arica, Glass said.

She later became director o the

National Institute o General Medical

Sciences, the rst woman to head an

institute, and between the departure

o Dr. Harold Varmus and the

appointment o Dr. Elias Zerhouni,

Kirschstein ran the NIH on an acting

basis.


http://slidepdf.com/reader/full/global-health-matters-september-october-2009 3/16www.fc.nih.gov 3

SEPT/OCT 2009

New synthetic protein could speed fu vaccine

HEMAGGLUTININRibbon diagram o hemagglutinin molecule.

S o ur c e : T h e N at i on al C ent er f or B i ot e ch n ol o g yI nf or m at i on

NIH scientists have developed a way

to drastically cut the time needed to

mass produce fu vaccines by cloning

the protective antigen protein and

growing it in bacteria instead o eggs.

The team o investigators rom the

National Institute o Child Health and

Human Development and the National

Institute o Allergy and Inectious

Diseases—together with Fogarty’s

director o international epidemiology,

Dr. Mark Miller—used the new

technique on several strains o avian

fu as well as the pandemic A/H1N1

strain.

Typically, development can take up to

six months, but using recombinant

hemagglutinin (rHA) antigens to create

a fu vaccine could take only three or

our weeks, Miller said.

“Infuenza vaccine production has

been using technology that’s over

50 years old,” he said, noting that

recombinant protein synthesis

is similar to the one that led to

widespread use o hepatitis B vaccinenow available worldwide or less than

50 cents a dose. That would make the

technique attractive to large countries

acing a shortage o vaccines now

under production by the big drug

companies.

“This is a vaccine construct that is not

commercially available now,” Miller

said. The new method, tested in mice

and errets is awaiting human clinical

studies as required by the Food and

Drug Administration prior to licensure.I successul, vaccine production

could scale up quickly, Miller added.

A number o international vaccine

manuacturers have expressed interest

to work urther with this product.

“The … methodology or producing

a rHA vaccine is cheaper, saer and

more productive than the available

technology to meet urgent needs

in a world health emergency,” theresearchers concluded in an article

published in the journal Vaccine .

Specically, they said, “Our protocol

eliminates the handling o live virus

and expensive egg propagation

systems or insect cell cultures and

acilitates the rapid production

(weeks) o high yields o immunogen…

compared to current methods

requiring one to two eggs per vaccine

dose and a minimum o six months

ater the circulating strain is isolated.”

Experiments supported by NIH

in extramural labs are pursuing

similar means or expedited vaccine

production, he said.

Other Fogarty scientists are also at the

oreront o research into A/H1N1.

Dr. Martha Nelson and Dr. Eddie

Holmes collaborated with researchers

in Wisconsin, New York and at the

J. Craig Venter Institute on a large-

scale analysis o the evolutionary

relationships o infuenza viruses

rom the current A/H1N1 pandemic.

Their work revealed that the virus

has already diversied into multiple

lineages that exhibit complex spatial

patterns and rapid growth dynamics.

In addition, Dr. Gerardo Chowell has

been analyzing historical pandemics

and the current A/H1N1 outbreak

in the U.S. Dr. Viggo Andreasen andDr. Kimberly Bloom-Feshbach have

been working on historical data rom

Scandinavian pandemics dating rom

1890 and Dr. Colin Russell has been

mapping how the fu virus ools the

immune system.

Finally, Drs. Cecile Viboud, Lone

Simonsen, Russell and Miller have

published lessons rom past infuenza

pandemics in the new PLoS Current,

a moderated, but not peer-reviewed,

online journal.

Biesova Z, Miller MA, Schneerson

R, Shiloach J, Green KY, Robbins

JB, Keith JM. “Preparation,

characterization, and immunogenicity

in mice o a recombinant inuenza

H5 hemagglutinin vaccine against the

avian H5N1 A/Vietnam/1203/2004

inuenza virus.” Vaccine . 2009 Aug 15

Miller, Mark; Viboud, Cécile; Simonsen,

Lone; Olson, Donald R.; Russell, Colin.

“Mortality and morbidity burden

associated with A/H1N1pdm inuenza

virus: Who is likely to be inected,

experience clinical symptoms, or die

rom the H1N1pdm 2009 pandemic

virus?” PLoS Currents Inuenza. 2009

Aug 26 [revised 2009 Sep 2]



SEPT/OCT 2009

A Kenyan woman and her child hold a new ID card, part o apatient identifcation system created through a Fogarty-supported inormatics program.

Seeking to increase inormatics expertise in low- and

middle-income countries, Fogarty has awarded more than

$9.23 million to eight global health inormatics programs

over the next ve years.

Fogarty’s Inormatics Training or Global Health program

supports the training o scientists in the design o

inormation systems and use o computer-supported

management and analysis in biomedical research. The

grants are being awarded to both new and ongoing

inormatics programs at various international sites.

Inormatics, the science o handling large volumes o

inormation, can help link physicians and researchers

around the world so that they can share knowledge ranging

rom the best care o patients to issues in collaborative

research.

“The application o inormatics allows our clinicians in

low-resource settings to leverage new technologies in order

to speed discoveries,” said Fogarty Director Dr. Roger I.

Glass. “These new awards will enable researchers to better

analyze data, compare results among populations and

quickly share ndings with colleagues around the world.”

Two o the awards will und new inormatics programs in

South America.

The rst is a collaborative eort between the University o

Pittsburgh and Javeriana University in Bogota, Colombia

to build the capacity o individuals in the eld o health

inormatics with an emphasis on clinical research.

The second grant will allow Oregon Health and Science

University to combine the existing strengths o its

inormatics and epidemiology program with that o the

Italian Hospital o Buenos Aires in Argentina to develop a

ocus in clinical and translational research inormatics.

Another grant will support the creation o the Andean

Global Health Inormatics Research and Training Center,

a regional center o excellence in global health inormatics.

The center will be administered by the Cayetano Heredia

University, with participation rom the U.S. Naval Medical

Research Center Detachment in Lima, Peru, the University

o Cauca in Colombia, the Andina University o Simon

Bolivar in Ecuador and the University o Washington in

Seattle.

A collaboration among researchers rom the University

o Georgia, the Oswaldo Cruz Foundation Rene Rachou

Research Institute and the Federal University o Minas

Gerais in Belo Horizonte, Brazil, and the Oswaldo Cruz

Collaborations unded to

develop inormatics expertise

Institute in Rio de Janeiro, will use its grant to bolster anexisting training project by expanding into new areas o

bioinormatics, epidemiology and molecular evolution, with

a ocus on tropical parasites and their vectors and hosts.

A grant awarded to the University o Caliornia, San

Diego, was initially developed to build capacity in Brazil.

The unding will allow or expansion into a South-South

network by extending inormatics curricula and training in

Portuguese to researchers in Maputo, Mozambique.

Vanderbilt University’s award will support a new

partnership with two leading research institutions in

India, the National AIDS Research Institute in Pune and

the National Institute o Epidemiology in Chennai. The

program will have an emphasis on HIV/AIDS and other

inectious diseases.

A longtime inormatics grantee, the University o KwaZulu-

Natal in South Arica, will develop research and training

capacity through a Pan-Arican collaborative initiative

involving institutions in Uganda, South Arica and

Zimbabwe. The unds will allow the University o KwaZulu-

Natal to continue to oer postgraduate while assisting

other universities in Arica to establish their own medical

inormatics training programs.

Another grant will support development o an East AricanCenter o Excellence in Health Inormatics. The center will

be a major resource or improving local human capacity or

health inormatics and clinical research in sub-Saharan

Arica, building upon an almost two-decade collaboration

between Indiana University and Moi University in Eldoret,

Kenya.

Participating with Fogarty as NIH unding partners in the

Inormatics Training or Global Health program are the

National Library o Medicine and the National Human

Genome Research Institute.



SEPT/OCT 2009

Recovery Act supports ve Challenge GrantsFogarty has awarded ve NIH Challenge Grants in Health

and Science Research with Recovery Act unds or diverse

studies in chronic diseases, climate change, emergingtechnologies and the eect o cultural belies on health.

The projects will receive about $4.7 million over the next

two years. The Challenge Grant program is intended to

jumpstart studies addressing specic scientic and health

research challenge areas in biomedical and behavioral

research.

“We’re extremely grateul or this stimulus unding and

the boost it’s providing to biomedical research, a critical

component o the U.S. economy,” said Fogarty Director Dr.

Roger I. Glass. “These grants will help support cutting-

edge research in priority areas and will enable scientists

to explore new ways to leverage emerging technologies toimprove human health.”

The eect o climate change on cholera outbreaks is the

subject o a study by Dr. Shaqul Islam o Tuts University.

Droughts, foods and cyclones have been associated with

major cholera epidemics, and extreme climatic events are

likely to bring about changes in the ecosystem that may

impact cholera bacteria.

The project, in collaboration with the University o

Maryland and the Institute o Water Modeling in

Bangladesh, will examine how sea level increases and

variations in precipitation might aect transmission o the

disease, which has re-emerged as a signicant cause o death

Dr. Robert Boyd, at the University o Caliornia, Los

Angeles, will lead a team conducting research on cultural

variation at sites on Yasawa Island, Fiji, and in Huatasani,

Peru. The unding will allow the team to develop a better

understanding o people’s cultural belies, which have

an important impact on diet, exercise, liestyle and other

aspects o public health.

Long-distance communication and distance learning

applications will be the ocus or University o Alabama at

Birmingham researcher Dr. Lynda Wilson.

The project will develop our courses, which will be oered

over a two-year period to 150 study coordinators at various

international sites.

The goal is to address the lack o adequate training or

research coordinators across the globe by employing a mix

o approaches, including Internet-based classes, courses

on CD-ROM, podcasts and text messaging.

Recovery Act unds will support fve Fogarty Challenge Grants, including one that will examine the eects o climate change on cholera in Bangladesh and other locationswhere it has re-emerged as a signifcant cause o death.

A study that analyzes how electronic protocols might

improve adherence by health care providers and patients

will be carried out by Dr. Marc Mitchell o Harvard

University. Mitchell and his team have designed sotware

that guides providers through protocols related to

childhood illnesses.

The sotware can be operated on a PDA or cell phone

and helps providers avoid skipping steps or arriving at

an inaccurate diagnosis. The study will be carried out

in Tanzania at Evangelical Lutheran Church clinics, all

o which currently use paper based protocols or the

treatment o children.

A University o Pennsylvania research team o Dr. John

Danesh, Dr. Daniel Rader and Dr. Danish Saleheen will

conduct a study on the poorly understood link between

diabetes and cardiovascular disease in South Asia, where

the number o people with type 2 diabetes is expected to

approach 100 million by 2030.

The team will generate new data on this link by working with an already existing heart disease study in Pakistan.

Overall, the NIH will award a total o at least $200 million

in Challenge Grants.

For more inormation, visit www.fc.nih.gov/recovery/

main.htm.



SEPT/OCT 2009

South American researcher gives

Chiles Lecture Dr. Eduardo E.

Castilla, a prominent South

American researcher into birth

deects, gave the annual Lawton

Chiles International Lecture on

Maternal and Child Health in the

Americas. The Latin AmericanCollaborative Study o Congenital

Malormation that Dr. Castilla

heads, has built a network o 84

hospitals in 60 cities across nine countries that reports

200,000 births a year to help with the Study’s goal o

“prevention through research.”

ART successul in HaitiGHESKIO, the long-time Fogarty AIDS training and

research grantee in Haiti, recently published data

indicating the success o sustainable antiretroviral

therapy (ART).

Researchers including Dr. Jean “Bill” Pape, the ounding

and current director o GHESKIO (the French acronym

or the Haitian Group or the Study o Kaposi’s Sarcoma

and Opportunistic Inections), enrolled 910 HIV-inected

patients in a clinical trial o dierent regimens and ound

that survival was tied strongly to adherence ater the

regimen was introduced.

Beore the advent o ART in Haiti in 2003, 90 percent o

AIDS patients died within a year and 100 percent within

two years. Ater ART, such patients had a 90 percent

survival rate ater one year and 79 percent ater ve years.

The death rate was seven times higher in the rst six

months o treatment than ater six months. Deaths ater

six months were associated with adherence o less than

90 percent, being over 50 years old and a tuberculosis

diagnosis in the rst six months o ART.

The study was sponsored in part by Fogarty.

Leger P, Charles M, Severe P, Riviere C, Pape JW, Fitzgerald

DW. “5-year survival o patients with AIDS receiving

antiretroviral therapy in Haiti.” N Engl J Med. 2009 Aug

20;361(8):828-9

Haitian researchers have proven anti-retroviral therapy programs are sustainable, evenin resource-poor countries. GHEKSIO clinics like this one report excellent retentionand adherence and a survival rate o 75% at 5 years.

Europe prepared orresearch “Renaissance” A recent report to the European Commission lays out six

goals intended to encourage a "Renaissance" in Europeanresearch by 2030. Based on current key research chal-

lenges, the report invokes the memory o the revolution

in thought, society and science during the Renaissance to

rame the changes needed now.

The European Research Area Board's rst annual report

calls or action to:

• create a united European research area

• nd solutions for the world's Grand Challenges

(climate change, energy supply, aging societies, etc.)

• encourage interaction between science and society

• foster collaboration between public and private sectors

• encourage scientic excellence

• promote cohesion

The report stresses the need to restore trust between sci-

ence and society, with a new social contract based on the ‘3

Rs’ : "rigor in decision making, political or scientic; respect

or our ellow man, scientist and environment and respon-

sibility or our own actions as scientist and citizens."

For additional inormation visit: http://ec.europa.eu/research/erab/

Castilla gives Chiles Lecture



SEPT/OCT 2009

Trans-NIH eort launched on global health...continued rom p. 1

Participants agreed to focus on three overarching issues:

• improving data collection on NIH international activities

• ensuring clinical trials supported by NIH meet the highest

possible standards no matter where they take place and

• developing strategies to position the NIH to play a s trategic

role in the U.S. government’s global health activities.

“I we don’t step orward and point out the value o research,

the ocus is likely to be increasingly on delivery, whicho course is critical,” Collins noted. “But we need the

research aspect o this to be vigorously supported.”

The genesis o the working group was the previousdirector’s leadership orum in 2007, during which a whitepaper was commissioned to detail the agency’s role inglobal health. Its recommendations guided a day-longdiscussion by NIH global health leaders last May.

Fogarty director Dr. Roger I. Glass, who also serves as theNIH associate director or international research, reportedto IC directors in June and received their support to ormthe standing working group on global health research.

acting director o the Oce o Extramural Research.

Foreign sites that receive direct awards rom the NIH arecaptured in the system but oreign components o domesticawards are not, she said. “We want to strengthen our database so we can understand the unding gaps.”

Rockey suggested a possible solution may involve creatinga new eld that grantees would be required to use to reporton oreign segments o domestic grants.

She agreed to co-chair a subcommittee on data collectionissues with Dr. Jim Herrington, Fogarty’s internationalrelations director.

A trans-NIH ramework to assist the planning and

implementation o international research projects wassuggested by Dr. Susan Shurin, acting director o theNational Institute o Child Health and Human Development

It could collect best clinical research practices and other guidance by country or region, including advice ondeveloping partnerships with NGOs and other governmentsOther issues such as regulatory requirements, tissuespecimen movement and human subjects’ protection couldalso be provided, she said.

Such shared inormation could reduce the time or contractnegotiations on oreign projects, encourage IRB reciprocity and help recruit clinical trial participants, noted NCRR

director Dr. Barbara M. Alving. A virtual “concierge o experts” could also be assembled to provide useul on-the-ground experience to other investigators.

A second subcommittee, led by Shurin and Dr. Hugh Auchincloss, deputy director o the National Institute o Allergy and Inectious Diseases, will develop the clinicaltrials resource.

It was also decided the group will convene country-specicmeetings to acilitate inter-IC collaboration and share best practices or engaging a specic country.

Collins told the group their work could prove to be

signicant and that he’d be cheering them on. “This is a moment, I think it’s a great scientic opportunity and it ts so well with what NIH is all about — which is scienceto serve the public, in this case the whole public.” The ull working group is scheduled to meet again in December.

High-level representatives o 18 ICs and the Oce o theDirector participated in the group’s inaugural session.

Participants agreed to ocus on three overarching issues— improving data collection on NIH international activities,ensuring clinical trials supported by NIH meet the highest possible standards no matter where they take place anddeveloping strategies to position the NIH to play a strategicrole in the U.S. government’s global health activities.

“When I came here to Fogarty, we had no data on NIH’scommitments and investments in global health nor on the

dierent areas o the world where people are invested and what they are doing,” Glass recounted.

There is still no comprehensive system to track the oreigninvestments made by NIH, acknowledged Dr. Sally Rockey,



SEPT/OCT 2009 FOCUS ON GLOBAL HEALTH ON CAMPUS

Campuses embracing global health

When today’s university administrators were going to

school, student demands were about politics or campus

living conditions. Today, the demands o students are

purely academic—more courses in global health, the

hottest eld in academia.

The numbers are staggering. Enrollment in global health

programs in universities across the United States and

Canada doubled in just three years due to a surging

interest in careers that address health disparities and

prevent the spread o disease in developing countries.

Academic leaders at the

Consortium’s recent

annual meeting at the NIH

were concerned about the

budgetary and structural

challenges acing university

global health programs, but

they marveled at today’s

students.

“I think our current

young generation has anunconsummated desire or

sacrice and service,” says

Dr. Michael Merson, director

o the Duke University Global Health Institute.

University o Washington President Mark. A. Emmert

explains the demand rom the point o view o a sel-

described Baby Boomer:

“Our generation o college students was a generation that

said, ‘We don’t want to live in a nation where people have

dierent rights and opportunities.’ Our students seem to be

saying, ‘I don’t want to live on a planet that doesn’t providethose same kinds o opportunities.’”

At Emory University, global health has become the largest

undergraduate minor on campus less than two years

ater it was established, with students representing 15

dierent majors. At its Rollins School o Public Health,

more applications are received or global health graduate

programs than or any other.

Fogarty Director Dr. Roger I. Glass introduces NIH Director Dr. Francis Collins to longtime Fogarty grantee Dr. Patricia Garcia, o Peru’s Cayetano Heredia University.

F O C U S

Nearly 300 members o the Corsortiumo Universities or Global Health rom60 institutions gathered at NIH or the group’s frst ofcial meeting.

P h ot o b y Wi l l K i r k , J oh n s H o pk i n s U ni v er s i t y

A survey o 37 institutions conducted by the Consortium

o Universities or Global Health ound:.

• The number o undergraduate students enrolled

in global health grew rom 1,286 to 2,687

between 2006 and 2009.

• The number o graduate students enrolled has

more than doubled rom 949 in 2006 to 2,010this year.

• Student organizations ocused on global health

now number 105, an average o almost three on

each campus.

• The 37 universities oer a combined 302

programs that have been in place or at least

one year in 97 countries.Boston University associate provost and ormer Fogarty director, Dr. Gerald Keusch(center), catches up with Fogarty staers Dr. Ken Bridbord (let) and Dr. Flora Katz (right) during the Consortium meeting at NIH.



SEPT/OCT 2009FOCUS ON GLOBAL HEALTH ON CAMPUS

“Programs in global health are attracting students rom

across the University with a wide range o interests,

including health sciences, business, law, theology, and

liberal arts disciplines,” says Emory’s Dr. Jerey Koplan.

The University o Maryland’s School o Public Health—

while comprising more than just global health—has seenundergraduate majors increase rom 757 to about 1,600

in just ve years, says Dean Robert Gold, noting that his

university president has challenged all students to engage

in some kind o international experience.

One thread running through the two-day CUGH meeting

was trying to dene what a seamless global health

education program ought to be—to the satisaction o

aculty in narrow disciplines, students seeking a broader

education and unding agencies that will support both.

The question was dened by Dr. Timothy F. Brewer o

McGill University as, “What basic minimum inormation—

whether you’re going to be a plastic surgeon, or you’re

going to be a amily practice doc or you’re going to be a

biochemist—should you have heard o in global health? …

What is the equivalent every medical doctor should know

about the burden o diseases?”

Specic criteria have yet to be developed, and some

conerence participants expressed the notion that

standardizing a list o competencies may be antithetical to

another popular notion that experts in a eld ought to do

what they do best.

Happily, global health is a eld where student demand is

actually matched with increasing job opportunities, says

Dr. Gerald Keusch, a ormer Fogarty director and now

associate provost or global health at Boston University.

“The job market is, in act, growing as more and more

money is coming into bilateral, multilateral and major

global health programs,” he says. “There is a need or

experience in the developing world, in government and in

the private sector.”

For more inormation about the survey, visit http://tiny

url.com/mzeexr

— DR. MICHAEL MERSON, Duke University Global Health Institute

I think our current young generation has an

unconsummated desire for sacrice and service.

“

”

Collaborations spurbiomedical innovations

When an

intravenous dripis not available

in resource-

poor areas, the

only way to

deliver fuids

is through the

bone, especially

in children.

A device to do just that costs about $10,000 in the

United States, but a collaboration between Stanord

University and research teams in India has produced anintraosseous fuid delivery system that can be produced

locally or under $2.

The intraosseous device and an articial knee costing

only $20 are among the success stories o the eight-

year-old Stanord-India Biodesign, a program that unites

researchers, engineers, designers and business students

to develop technology to improve health and catalyze

growth o biomedical industry in the world’s second

largest nation.

The program was eatured at the recent meeting at the

NIH o the new Consortium o Universities or GlobalHealth.

“We eel innovation is something that can be taught,”

Srivastava said. “It is a discipline. It requires diligence.”

Advanced students are selected rom around the world

to participate in the highly structured program, which

begins with “clinical immersion” or those who are not

trained in medicine. Teams o our are taught to observe

unmet clinical needs, catalogue them and come up

with one or two or which innovative solutions can be

developed, modeled and brought to market.

The Stanord researchers collaborate with counterparts

rom the All India Institute o Medicine and the Indian

Institute o Technology to address needs in that country.

“It’s an opportunity to really alleviate human suering on

a large scale and to help catalyze an industry that osters

a sustainable model,” Srivastava explained. The hope is

“to create a global paradigm that is replicable to other

parts o the world.”



SEPT/OCT 2009 FOCUS ON GLOBAL HEALTH ON CAMPUS

...continued rom p. 1

Meeting attendees hear ’stars are aligned’

elds. A CUGH survey o 37

institutions ound that both

undergraduate and graduateenrollment in global health

programs had more than

doubled since 2006.

In opening the two-day CUGH

meeting, Collins told the

nearly 300 leaders rom 60

universities that “global health

is great science, but it’s also

a great responsibility and a

great opportunity to reach out

and try to do things across the

world instead o ocusing somuch on ourselves, so go to it

… I will be cheering and trying to help in every way I can.”

White House health adviser Dr. Ezekiel Emanuel, a

bioethicist with the NIH Clinical Center, and U.S. Global

AIDS Coordinator Ambassador Eric Goosby emphasized

the administration expects concrete “deliverables,” not

just measures o procedural progress in the eorts against

inectious and chronic diseases and maternal and child

mortality.

“Getting a bigger bang or the buck is not just an economic

outcome,” Emanuel said. “It is an ethical imperative” because wasting money means “someone else will not get a

resource that could have been more valuably used.”

Goosby said the administration’s Global Health Initiative

will be a seed or a broader discussion that will move rom

bilateral to multilateral” eorts and use the success o the

President’s Emergency Program or AIDS to expand delivery

o other health services in host countries.

He said it is incumbent on those countries to develop their

own cadre o credentialed health care workers by working

with national medical and nursing schools. One o the

more dicult problems, he said, is getting governmentsto improve civil service pay in order to retain their best

researchers and clinicians, who requently move to better

positions in the private or nonprot sectors.

Both ocials strongly supported integrating overseas

health services programs to avoid duplication among

U.S., private and nonprot organizations and making

emergency programs fower into long-term inrastructure

improvements in developing countries.

At a meeting o Fogarty’s advisory board, Jennier Klein, a

senior adviser in the State Department’s Oce o Global

Women’s Issues, conrmed administration support or therole o universities in ashioning details o the Global Health

Initiative. “We very much have in mind to seek input and

an ongoing partnership with the academic community,” she

said.

Support also came rom Capitol Hill, where Rep. Betty

McCollum, D-Minn., co-chair o the Congressional Global

Health Caucus, hosted a CUGH brieng, where Dr. Judith

Wasserheit, vice chair o global health at the University o

Washington, proclaimed Fogarty “a secret weapon and a

real hidden jewel” that trains “the vast majority” o health

policy leaders in the developing world at a cost o less than

¼ o 1 percent o the total NIH budget.

Former House Health Appropriations subcommittee

chair John Porter, R-Ill., now chair o the advocacy group

Research!America, cautioned that “politics is unpredictable

and good leaders in oce today could be gone tomorrow.”

He said increased unding or global health “will take time,

but in my judgment it can be done.”

According to Research!America President Mary Woolley,there is widespread public support, with 81 percent o

respondents in a survey it commissioned believing either

strongly or somewhat that it is important or the United

States to work or global health through research.

In addition to Fogarty, sponsors o the meeting were: Bill

& Melinda Gates Foundation, Rockeeller Foundation,

National Institute o Allergy and Inectious Diseases and

the Foundation or the National Institutes o Health.

White House adviser Dr. Ezekiel Emanuel told the Consortium o Universities or Global Health meetingattendees that ”Getting a bigger bang

or the buck is not just an economic outcome, it is an ethical imperative.”

Ambassador Eric Goosby, U.S. Global AIDS Coordinator, said he hopes to build onPEPFAR’s success to expand delivery o other health services in host countries.



SEPT/OCT 2009FOCUS ON GLOBAL HEALTH ON CAMPUS

The University o Southern Caliornia is taking advantag

o its digitally savvy students on a campus where creativ

is a natural part o the curriculum and electronic games

have become learning devices.

“We are using gaming to develop virtual simulations tha

are engaging and rooted in science and can be used as a

teaching tool or global health students, says Dr. Heath

Wipfi.

Games like “Immune Attack” or “Darur is Dying” use re

data and can be tailored to specic health problems or

by students in coming up with new solutions.

Wipfi says the USC “Global Response Health Engine”

program provides an example o what ve university

presidents advised during the CUGH meeting—using

an institution’s unique strengths to build global health

curricula.

At USC, where gaming is already part o other courses,

the medical school where Wipfi teaches collaborates witschools o cinema, engineering, communications, busine

ne arts, music, arts and sciences and with the Los Ang

gaming industry itsel.

“It’s less about acts and gures and more about teachin

students how to access inormation and how to judge

whether it is credible inormation or not,” she says. “We

want to make it very clear, gaming is serious business.

We are not just playing around here.”

USC tries video gamesas teaching tool The Consortium o Universities or Global Health sprang

rom an idea conceived by ormer Fogarty Director Dr.

Gerald Keusch. Last year, it held its rst organizing

meeting among 20 members at the University o Caliornia, San Francisco.

There are 58 members now, and the our criteria or

membership are:

• A well-established global health program

• An interdisciplinary program nearly always

involving more than one school

• Activities encompassing education and training,

research and service

• A well-established and unctioning international

partnership

Dr. Haile T. Debas o the University o Caliornia, SanFrancisco, chairman o the ounding board o directors,

outlines some o the Consortium’s rst priorities:

• Dening what is meant by global health

education in terms o curricula and

competencies

• Collaborating among members in research,

training and service

• Developing a common “platorm” or members to

acilitate their work overseas

• Developing policy and advocacy in support o

global health

•

Creating international partnerships or humanand institutional capacity building

“I am hopeul that the Consortium will ensure that wecatch the crest o the wave o excitement and idealismin our students and aculty to make universities a transorming orce in global health,” Debas says.

What is CUGH?

Rep. Betty McCollum, D-Minn., greets Duke University’s Dr. Michael Merson at aCapitol Hill briefng she hosted as co-chair o the Congressional Global Health Caucus.Also pictured are Boston University’s Dr. Gerald Keusch and Dr. Donald Thea.



SEPT/OCT 2009

Causes o suicide dier A large international mental health survey has ound that suicide rates do not dier much based on a country’s level

o development, but the causes do.

Writing in the journal PLoS Medicine in August, a global

team o researchers including Fogarty grantee Dr. Ronald

Kessler o Harvard University, analyzed results rom

structured interviews conducted or the World Health

Organization with nearly 110,000 people rom 21 countries.

“Overall, mental disorders were equally predictive (o

suicide) in developed and developing countries, with a key

dierence being that the strongest predictors o suicide

attempts in developed countries were mood disorders, whereas in developing countries impulse-control, substance

use and post-traumatic stress disorders were most

predictive,” the research concluded.

The paper also ound that although depression is a

strong predictor o suicide, it is because it leads to thinking

o killing one’s sel, whether or not the act is carried out.

The ndings also show that only hal the people who

US-Latin America commit to ghting cancer Argentine Ambassador Héctor Timerman (let), National

Cancer Institute Director Dr. John E. Niederhuber and

Urugayan Minister o Public Health Dr. Mária Julia

Muñoz, sign letters o intent to collaborate in cancer

research. Along with Chile, which signed such a letter

with the U.S. in June, these countries comprise the

United States-Latin America Cancer Research Network,

which is committed to developing a comprehensive

understanding o the cancer burden among Hispanic

populations in Latin America and the United States and

to enhance the cancer research and care inrastruc-

tures in both regions o the hemisphere.

Impulse-control, substance use and post-traumatic stress disorders are the strongest

predictors o suicide attempts in developing countries.

More ino at: www.c.nih.gov/news/subscriptions.htm

Can’t wait for the latest funding

announcements and NIH news?

A report by the Guttmacher Institute links the increased

use o contraception worldwide to the reduction o

unintended pregnancies, which declined rom 69 per 1,000

women age 15 to 44 in 1995 to 55 per 1,000 in 2008. At

the same time, abortions declined rom an estimated 45.5

million in 1995 to 41.6 million in 2003. The report said

abortion occurs at roughly equal rates in countries where

it is broadly legal and where it is not. The dierence is that

illegal, clandestine abortions cause signicant harm to

women, more so in developing countries. http://tinyurl.

com/yhrt7ad

Drop in abortion linked to contraception

have seriously considered suicide actually have a mental

disorder.

Nock MK, Hwang I, Sampson N, Kessler RC, Angermeyer

M, et al. (2009) Cross-National Analysis o the Associations

among Mental Disorders and Suicidal Behavior: Findings

rom the WHO World Mental Health Surveys. PLoS Med 6(8):

e1000123.



SEPT/OCT 2009

Deadly malaria parasite came rom chimps

A team o international genetic detectives led by renowned

Fogarty grantee Dr. Nathan Wole has determined that the

malaria parasite that kills more than 1 million people a

year originated rom a chimpanzee parasite and did not,as was previously believed, co-evolve as the human and

chimpanzee lineages split rom a common ancestor.

The groundbreaking analysis was made possible by the

team’s identication o eight new isolates o the parasite,

Plasmodium reichenowi, which inects chimpanzees.

The new genetic materials came rom 84 wild or wild-borncaptive chimps in Cameroon and Côte d’Ivoire.

The researchers, writing in Proceedings o the National

Academy o Sciences , were able to conclude that the deadly

human parasite, Plasmodium alciparum, is a airly recent

descendent o the more genetically diverse and thus, older

chimpanzee parasite.

Previous studies, which strongly suggested the two

parasites had developed independently, one in humans

and one in chimps rom a common ancestor millions o

years ago, had been based on only a single isolate o the

chimpanzee parasite.

Instead,“phylogenetic analysis indicates that all extant P.

alciparum populations originated rom P. reichenowi , likely

by a single host transer, which may have occurred as early

as 2-3 million years ago, or as recently as 10,000 years

ago,” the authors wrote.

Part o Wole’s work in collecting the specimens was

supported by a Fogarty International Research Scientist

Development Award.

Stephen M. Rich, Fabian H. Leendertz, Guang Xu, Matthew LeBreton, Cyrille F. Djoko, Makoah N. Aminake, Eric E.

Takang, Joseph L. D. Dio, Brian L. Pike, Benjamin M.

Rosenthal, Pierre Formenty, Christophe Boesch, Francisco

J. Ayala and Nathan D. Wole. “The origin o malignant

malaria.” PNAS 2009 106:14902-14907; published online

beore print August 3, 2009.

P h ot o c o ur t e s y of Gl o b al V i r al F or e c a s t i n gI ni t i at i v e

SPEAKER: Dr. Julio FrenkDean, Harvard School o Public Health Tuesday, December 15, 2009

11:30 a.m. -12:30 p.m.MASUR AUDITORIUMClinical Center (Building 10), NIH

2009 David E. Barmes Global Health LectureSponsored by the National Institute o Dental and Cranioacial Research

and the Fogarty International Center

Reception to ollow hosted by the Friends o the NIDCR

S A V E T H E D A T E

“Globalization and Health: The Role of Knowledge in an Interdependent World”



SEPT/OCT 2009

The past decade has seen an enormous increase in the

number o North American universities oering new

programs addressing global health challenges. This

remarkable response to the international global health

crisis refects the desire o our aculties and students

to bring the unique resources o the university to

bear on problems that require sustained, integrated,

interdisciplinary, and collaborative approaches.

We must train the next generation o health proessionals

to help ensure a healthier uture or people everywhere.

While our schools o medicine, public health, andnursing are central to these eorts, the university has

much more to oer. We recognize that to truly address the

myriad o global health problems aecting the poor and

disenranchised requires more than good medicines and

dedicated health care proessionals. Our broader global

health initiatives are building on our historical strengths.

For example, our schools o engineering, architecture and

urban planning are able to address inrastructure needs or

clean water and sae sewage systems and injury prevention.

Our environmental sciences aculty and students are in

the vanguard in addressing the impact o climate change

on the health o human populations around the globe. Our schools o public aairs and public policy and law develop

policy and governance structures that promote health, and

together with aculty in bioethics and philosophy address

the human rights dimensions o global health and the

challenges o achieving global justice more broadly.

Our students and aculty have enthusiastically embraced

our growing investment in global health programs. Their

desire to act is driven in part by the global communications

revolution that brings the reality o human suering

and health inequities to everyone. We are excited by the

evidence o interest and concern or global health that

we see every day in our institutions, rom our aculty,

our students, and our sta. This is one o the best

indications that our institutions will continue to oster

global citizenship into this century and beyond, and we

commit ourselves to involving our institutions in achieving

a healthier, better educated, more equitable, and peaceul

world.

We urge policymakers and health-related oreign assistance

programs to use the resources and global health expertise

Making a dierence in global health

GUEST OPINION

Five university presidents addressed the Consortium o Universities or Global HealthMeeting and released a joint statement on the importance o global health on their campuses. From let, Dr. Mark Emmert, Dr. James Wagner, Dr. Ronald Daniels, Dr.Michael Merson (moderator), Dr. Richard Brodhead and Dr. Robert Brown.

o our universities to deliver high quality, evidence-based,

cost-eective, and sustainable assistance to partner

nations. We stand ready to do so.

However, there is a need or resources that will enable us

to prevent disease and reduce mortality around the world

by supporting the global health research, technology and

engineering eorts o our aculty and more importantly,

enable us to provide opportunities or the thousands o

students, trainees and graduates o our universities and at

our partner universities, which are clamoring to become

involved and make a dierence in global health.

President Robert A. Brown, Boston University

President Richard H. Brodhead, Duke University

President James W. Wagner, Emory University

President Ronald J. Daniels, Johns Hopkins University

Principal Heather Monroe-Blum, McGill University

President John L. Hennessy, Stanord University

President Mark G. Yudo, University o Caliornia

President Mark A. Emmert, University o Washington

This statement, edited or space, was issued during the

Consortium o Universities or Global Health meeting held at NIH.



SEPT/OCT 2009

HEALTH BriesFour new staff join Fogarty Three program ocers and a program

analyst have joined Fogarty in recent

weeks.

Dr. Rob Lyerla, ormerly a

CDC epidemiologist with

a background in HIV/

AIDS surveillance, is

now the program ocer

or Europe. He has

eld experience in Denmark, France,

Moldova, Portugal, Romania, Russia,

Spain, Ukraine and Uzbekistan.

Dr. Myat Htoo Razak

will work on project

development and the

Fogarty International

Clinical Scholars/

Fellows program. He

received his medical degree in Burma

and a master’s in public health and a

doctorate in epidemiology rom UCLA.

Dr. Yvonne Njage, an

American Association

or the Advancement o Science ellow,

will manage the new

Millennium Promise

Awards program or research training

in chronic diseases. She has an M.D.

rom Harvard and has worked in

Kenya, Botswana, Zambia and India.

Farah Bader is providing

analytic support

or Fogarty grants

awarded under the

American Recovery andReinvestment Act. She

holds a master’s in public health rom

Johns Hopkins University and has

worked on problems o Iraqi reugees

in Jordan.

P E O P L ECenter-backed investigator wins Heinz Award

Dr. Kirk Smith,

a co-investigator

on the Fogarty-

sponsored

international

environmental

and occupation

health research

training program,

is one o 10

winners o the $100,000 Heinz Awardor his work on pollution in the

developing world. The award, named

ater the late Sen. John Heinz, cited

the University o Caliornia, Berkeley,

proessor or his work on the danger o

the global practice o cooking indoors

with wood, coal or other biomass.

(See. Global Health Matters, Vol. 8,

Issue 2, p. 10).

Grantee elected to Institute

of Medicine A long-time

Fogarty grantee,

Dr. Waaa El-

Sadr, ounder

o Columbia

University’s

Center or

Inectious Disease

Epidemiologic

Research,

has been elected to the Institute o

Medicine, one o the highest honorsin medicine. She serves on the

scientic advisory committee o the

Center’s AIDS International Training

and Research Program and was an

investigator in the Fogarty-unded

Centre or the AIDS Programme o

Research in South Arica.

Global

About 10 percent of births are prematurAbout one in 10 births worldwide is premature,

resulting in 1 million neonatal deaths a year,

according to World Health Organization data analyz

by the March o Dimes. The estimate o 12.9 million

premature births annually is conservative, analysts

believe because ew countries keep good statistics

http://tinyurl.com/y9k3prr

Alzheimer’s cases increasing rapidly

The number o cases is growing so rapidly, the Wor

Health Organization ought to make Alzheimer’s

disease a global health priority, says the nonproft

Alzheimer’s Disease International organization. It

estimates 35 million people around the world have

Alzheimer’s and other orms o dementia, a 10 perc

increase over 2005.http://tinyurl.com/mdhmba

Paper explores disparity in disease

fundingA recent article in the Bulletin of the World Health

Organization argues that certain diseases are avo

by unders because advocates have made them see

more important than others, regardless o the dise

burden. Author Dr. Jeremy Shiman o Syracuse

University says advocates are eective when they

emphasize the threat to human well-being, nationa

security and economic development. http://tinyurl.

com/yckytb6

Lancet issue devoted to South Africa

A collaboration among The Lancet and academicinstitutions in the country has produced a special

edition o the journal devoted to chronic diseases a

health delivery in South Arica. The series o paper

culminates in a call or action or the South Arican

government, universities, training institutions, hea

councils, researchers and civil society to strength

the country’s health care system. http://tinyurl.com

yboxq99


http://slidepdf.com/reader/full/global-health-matters-september-october-2009 16/16

Funding Opportunities

SEPT/OCT 2009

Global Health MattersSeptember/October 2009

Volume 8, No. 5 ISSN:1938-5935

Fogarty International Center

National Institutes of Health

Department of Health Human Services

Publication No. 07-5369

Managing editor: Ann [email protected]

Editor: Ira R. [email protected]

Contributing writer: Jeff Gray

Web manager: Anna Pruett Ellis

Grant application orms revised, shortenedShorter new paper and electronic orms will be required or

scal 2011 grant applications due on or ater Jan. 25, 2010.

The orms, including those or training and career development

grants, also will be restructured to streamline the inormation

as part o an overall NIH eort begun last year to revamp the

peer-review system. Changes will be made to the research plan,

resources and biographical sketch sections o the application.Between now and December, NIH will publish new Funding

Opportunity Announcements without accompanying electronic

application packages.

All new or resubmission applications must use the revised

application orms and instructions even i the initial

submission ollowed the current application orms and

instructions.

For details, visit http://tinyurl.com/nursul

For more information, visit www.fic.nih.gov/funding

Programs Details Deadline

Ecology o Inectious

Diseases Initiative

Global Research InitiativeProgram, Basic/BiomedicalResearch Award

Fogarty InternationalResearch Collaboration,Basic/Biomedical ResearchAward

All Fogarty FundingOpportunities

http://www.c.nih.gov/eid/ Dec. 9, 2009

http://www.c.nih.gov/grip/ Dec. 18, 2009

http://www.c.nih.gov//rca/ Jan. 28, 2010

http://www.c.nih.gov/unding/

Photo at bottom o page 1courtesy o Yale University.

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